This program project application supports a program of interdisciplinary research with central themes related to palliative care, quality of life (QOL), and symptom management across the trajectory of lung cancer affecting 213,000 Americans. The synergy across 3 interrelated but distinct research projects focused on lung cancer will be enhanced through this program project. Consistent with the recommendations of the Institute of Medicine Report on palliative care, we believe that palliative care including symptom management and attention to QOL concerns of patients and families should be addressed throughout the trajectory of lung cancer. This proposal addresses the NCI identified research areas of clinical research and cancer control in the focus areas of QOL and symptoms in lung cancer. Three projects are proposed: Project 1 is Early Stage Lung Cancer (N=207), and provides a model of integrating palliative care throughout the trajectory of disease. Project 2 focuses on Late Stage Lung Cancer (N=326), a population who have decreased survival and high QOL and symptom concerns. Project 3 focuses on Family Caregivers (N=533) of patients with lung cancer. The burden on caregivers of patients with lung cancer, both early and late stage, has been documented as very significant and few studies have addressed the specific needs of family caregivers in this population. Conducting this project simultaneously has great synergy allowing us to access family caregivers of lung cancer patients, a group rarely studied. Three cores are included in this program project proposal. The Administrative Core (Core A) will conduct the work of organizing the investigators, evaluating the progress on project goals and the timeline and monitoring the overall budget. The Biostatistics Core (Core B) contributes to study design, sampling designs, power analyses, and has assisted in finalizing the methodological approach, including statistical design for the three projects. The Geriatrics Core (Core C) will be responsible for measurement and analysis of geriatric outcomes across the three projects. This project has great significance to public health given the significant numbers of people diagnosed with lung cancer and the associated individual and societal costs. RELEVANCE: Lung cancer impacts elderly patients, creates extensive family and social burden and both psychosocial and financial consequences are substantial. Integration of palliative care into quality lung cancer care can serve as a public health model to maximize both quality of life and health care resources. The Institute of Medicine (IOM) report on end of life care documented the urgent need for models of care to integrate palliative care from the time of diagnosis for people with cancer.